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Biomaterials for resolution of peri-implantitis: Consensus report of Workgroup 2 of the IADR Implantology Research Group Best Evidence Consensus Symposium on Peri-Implant Disease and Its Treatment
Journal article   Open access   Peer reviewed

Biomaterials for resolution of peri-implantitis: Consensus report of Workgroup 2 of the IADR Implantology Research Group Best Evidence Consensus Symposium on Peri-Implant Disease and Its Treatment

Sukirth M Ganesan, David R Fraser, Mustafa Tattan, Jessica M Latimer, Georgios Kotsakis and IADR IRG Peri‐Implantitis Best Evidence Consensus Working Group 2
Journal of periodontology (1970)
03/30/2026
DOI: 10.1002/JPER.24-0432
PMID: 41910466
url
https://doi.org/10.1002/JPER.24-0432View
Published (Version of record) Open Access

Abstract

Peri-implantitis is a destructive disease affecting the tissues surrounding dental implants. Biomaterials may be applied during surgical treatment to reconstruct bony defects and support soft tissue healing. However, current evidence is unclear if these treatments increase the likelihood of peri-implantitis resolution. A systematic review and meta-analysis was performed on randomized controlled trials (RCTs) comparing surgical treatment with addition of reconstructive biomaterials (intervention) versus surgical treatment of peri-implantitis alone (comparison) with follow-up periods of at least 12 months. Resolution of peri-implantitis, defined as a reduction of probing pocket depth (PPD) to ≤5 mm, absence bleeding on probing (BOP), and stable or decreasing radiographic defect level (RDL), was selected as the primary outcome. Secondary outcomes included RDL reduction, buccal mucosal recession (REC), and patient-related outcome measures (PROMs). Risk of bias and quality of evidence were calculated using established guidelines. Seven studies reporting on 402 patients with 405 implants met inclusion criteria. Wide variations in outcome reporting prevented the synthesis and quantitative comparison of peri-implantitis disease resolution between intervention and comparison groups. Individual meta-analyses showed a weighted mean difference (WMD) in PPD reduction of 0.28 mm [95% confidence interval (CI) -0.30, 0.86] and a relative risk (RR) for absence of BOP of 1.11 (95% CI 0.78, 1.59) for the inclusion of biomaterials (intervention) over access flap alone (comparison). For RDL reduction, a WMD of 1.08 mm (95% CI 0.41, 1.74) with significant heterogeneity (Q p-val: < 0.01, I : 85%) and for REC, a WMD of -0.38 (95% CI -0.66, -0.11) was found, both in favor of the intervention. Analysis of the heterogeneity affecting RDL identified a positive effect on RDL when hydrogen peroxide but not rotary titanium brushes were used as an adjunct for implant surface debridement. Current evidence suggests that incorporating reconstructive biomaterials into surgical treatment may not definitively enhance the likelihood of peri-implantitis disease resolution. However, this lack of effect may be due to other factors such as implant surface treatments which may also affect clinical outcomes. Overall, this work highlights the critical need for standardizing the reporting of composite outcomes for the resolution of peri-implantitis disease and controlling for implant surface treatment effects when assessing reconstructive biomaterials. Peri-implantitis is a destructive disease affecting tissues around dental implants. We studied whether adding reconstructive biomaterials (i.e., biomaterials used to improve the likelihood of new bone formation or bone defect fill) to surgical treatments improves the clinical condition, meaning no further bone loss, probing pocket depths (PPD) ≤5 mm, and no bleeding on probing (BOP). We reviewed randomized controlled trials (RCTs) comparing surgery with biomaterials to surgery alone with at least 12 months of follow-up. The main outcomes measured were PPD reduction, absence of BOP, and radiographic defect level (RDL). Secondary outcomes included RDL change, buccal mucosal recession (REC), and patient-related outcomes (PROMs). Seven studies with 402 patients and 405 implants were analyzed. Due to variations in outcome reporting, it was challenging to compare the effectiveness of treatments. However, some individual analyses showed a small improvement in PPD and BOP with biomaterials. For RDL reduction, biomaterials showed better results, but with significant variability. REC also improved slightly with biomaterials. The analysis also suggested that using hydrogen peroxide, but not rotary titanium brushes, for implant cleaning could positively affect bone levels. The study concluded that adding biomaterials to surgical treatment does not definitively improve peri-implantitis resolution, possibly due to other factors like implant surface treatments. This study emphasized the need for standardized reporting and considering these factors in future research.
 peri‐implantitis biomedical and dental materials dental implants disease management

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